Provider Demographics
NPI:1760809586
Name:L I DENTISTRY AND SMILE DESIGN II, P.C.
Entity Type:Organization
Organization Name:L I DENTISTRY AND SMILE DESIGN II, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PORFIRIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:212-795-3246
Mailing Address - Street 1:612 W 178TH ST
Mailing Address - Street 2:1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6550
Mailing Address - Country:US
Mailing Address - Phone:212-795-3246
Mailing Address - Fax:212-795-3249
Practice Address - Street 1:612 W 178TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6550
Practice Address - Country:US
Practice Address - Phone:212-795-3246
Practice Address - Fax:212-795-3249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:L I DENTISTRY AND SMILE DESIGN, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0514241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty